Position Summary:

• Care for ill, injured, or convalescing patients or persons with disabilities in hospitals, nursing homes, clinics, private homes, group homes, and similar institutions.
• May work under the supervision of a registered nurse. Licensing required.

Reports To:

• Contracted Medical Facility’s onsite Nurse Manager/Supervisor, Physicians
• Cynet Health Account Manager
• Cynet Health Director of Nursing

Duties and Responsibilities:

• Performs admission, concurrent, and retrospective reviews on all patients.
• Ensures that status and level of care determination are accurate upon admission.
• Ensures that pre certifications/authorizations are obtained and documented appropriately for all admissions, surgeries, and procedures.
• Follows Medicare guidelines regarding utilization review.
• Submits telephonic and/or fax notification/clinical information
• Follows up with insurer for authorizations.
• Identifies potentially high risk patients and refer to Social Work.
• Provides coaching to physicians as needed regarding effective clinical documentation Conducts Initial Assessments to develop plan of care.
• Ensures that treatment plan is implemented, re-evaluated, and updated daily
• Facilitates effective communication between members of the treatment team
• Coordinates meetings w/ families and treatment team
• Facilitates arrangement of post-acute care services
• Acts as an advocate for the patient/family
• Follows Medicare guidelines regarding patient choice, admit/discharge notifications, and appeals.
• Maintains accountability for facilitating clinical patient progression through a defined plan of care to achieve optimal outcomes.
• Identifies, document, and report quality, cost, and risk variances related to patient’s plan of care.

Minimum Job Requirements:

• Graduate of an accredited school of nursing, with current licensure in state practicing in
• good standing in the state of practice.
• Evidence of minimum two years of current hospital experience.
• Evidence of current BLS credential mandatory.